Trend Toward High-Volume Hospitals and the Influence on Complications in Knee and Hip Arthroplasty
Trend Toward High-Volume Hospitals and the Influence on Complications in Knee and Hip Arthroplasty
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DOI：
10.2106/jbjs.15.00399
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发表时间：
2016-05-04
影响因子：
5.3
通讯作者：
Bhattacharyya, Timothy
中科院分区：
文献类型：
--
作者：
Laucis, Nicholas C.;Chowdhury, Mohammed;Bhattacharyya, Timothy
背景：据观察，进行大量关节置换术的医院具有更好的结局。随着关节成形术数量的增加，尚不清楚手术病例是否转移到了高容量医院。在这项研究中，我们检查了关节置换术量的变化，以提供“高容量”中心的当代定义，量化转移到高容量中心的手术量，并调查对并发症的影响。方法：数据来自美国国家（全国）住院患者样本（2000年至2012年）用于量化全髋关节置换术（THA）和全膝关节置换术（TKA）量的趋势。通过使用医院标识符（指示医院的地理位置），按医院对择期初次THA和TKA进行识别和分组。县的地理和人口数据来自美国人口普查，并计算了医院与县质心之间的距离。风险标准化手术并发症发生率的医院（2009年至2012年），从医疗保险医院比较和分组的医院volume.Results：从2000年至2012年，有一个显着增加的医院数量进行了合并量>= 400选择性原发性THA和TKA。每年进行的择期初次TKA和THA的数量从343，000例增加到851，000例。2012年，65.5%的关节置换术是在高容量医院（每年>= 400例关节置换术）进行的，26.6%的关节置换术是在非常高容量医院（每年>= 1，000例手术）进行的。在低容量医院进行的关节成形术的比例（
Background: Hospitals in which a high volume of arthroplasty procedures are performed have been observed to have better outcomes. As the number of arthroplasties has increased, it is not known whether surgical cases have shifted to high-volume hospitals. In this study, we examined the change in the volume of arthroplasties to provide a contemporary definition of "high-volume" centers, quantified surgical volume that shifted to high-volume centers, and investigated the resulting effect on complications.Methods: Data from the National (Nationwide) Inpatient Sample (2000 to 2012) were used to quantify trends in total hip arthroplasty (THA) and total knee arthroplasty (TKA) volume. Elective primary THAs and TKAs were identified and grouped by hospital by utilizing the hospital identifier, which indicates the geographic location of the hospital. County geographic and population data were obtained from the U.S. Census, and the distances between hospitals and the centroids of counties were calculated. Risk-standardized surgical complication rates for hospitals (2009 to 2012) were obtained from Medicare Hospital Compare and grouped by hospital volume.Results: From 2000 to 2012, there was a marked increase in the number of hospitals that performed a combined volume of >= 400 elective primary THAs and TKAs. The number of elective primary TKAs and THAs performed annually increased from 343,000 to 851,000. In 2012, 65.5% of the arthroplasties were performed in high-volume hospitals (>= 400 arthroplasties annually), and 26.6% of the arthroplasties were performed in very high-volume hospitals (>= 1,000 procedures annually). The proportion of arthroplasties performed in low-volume hospitals (